Resolution of severe paraplegia due to aortic dissection after CSF drainage

Abstract

Spinal cord infarction is a devastating and often permanent complication of aortic dissection. Generally, when paraplegia is complete, treatment is not beneficial. CSF drainage has been proposed to reduce the risk of spinal cord injury during aortic vascular surgery1 and in the postoperative period has been successful in a small number of patients with delayed spinal cord deficits.2 Although not confirmed by a randomized prospective study,3 CSF drainage continues to have advocates.2 We describe a woman with a DeBakey type IIIb4 aortic dissection, complicated by a virtually complete anterior spinal artery syndrome. Neurologic symptoms dramatically resolved immediately after lumbar CSF drainage. This is at least the second reported case in which CSF drainage reversed acute neurologic deficits complicating aortic dissection.5 A 66-year-old woman with hypertension presented with acute severe back pain. She …